Time to Benefit of Sodium-Glucose Cotransporter-2 Inhibitors Among Patients With Heart Failure

IMPORTANCE Emerging evidence has consistently demonstrated that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart failure (HF) hospitalization and cardiovascular (CV) death among patients with HF. However, it remains unclear how long a patient needs to live to potentially benefit from SGLT2 inhibitors in this population. OBJECTIVES To estimate the time to benefit from SGLT2 inhibitors among patients with HF. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study systematically searched PubMed for completed randomized clinical trials about SGLT2 inhibitors and patients with HF published until September 5, 2022; 5 trials with the year of publication ranging from 2019 to 2022 were eventually included. Statistical analysis was performed from April to October 2022. INTERVENTION Addition of SGLT2 inhibitors or placebo to guideline-recommended therapy. MAIN OUTCOMES AND MEASURES The primary outcome was the time to first event of CV death or worsening HF, which was broadly comparable across the included trials. RESULTS Five trials consisting of 21 947 patients with HF (7837 [35.7%] were female; mean or median age older than 65 years within each trial) were included. SGLT2 inhibitors significantly reduced the risk of worsening HF or CV death (hazard ratio [HR], 0.77 [95% CI, 0.73-0.82]). Time to first nominal statistical significance (P < .05) was 26 days (0.86 months), and statistical significance was sustained from day 118 (3.93 months) onwards. A mean of 0.19 (95% CI, 0.12-0.35) months were needed to prevent 1 worsening HF or CV death per 500 patients with SGLT2 inhibitors (absolute risk reduction [ARR], 0.002). Likewise, 0.66 (95% CI, 0.43-1.13) months was estimated to avoid 1 event per 200 patients with SGLT2 inhibitors (ARR, 0.005), 1.74 (95% CI, 1.07-2.61) months to avoid 1 event per 100 patients (ARR, 0.010), and 4.96 (95% CI, 3.18-7.26) months to avoid 1 event per 50 patients (ARR, 0.020). Further analyses indicated a shorter time to benefit for HF hospitalization and among patients with diabetes or HF with reduced ejection fraction. CONCLUSIONS AND RELEVANCE In this comparative effectiveness research study of estimating the time to benefit from SGLT2 inhibitors among patients with HF, a rapid clinical benefit in reducing CV death or worsening HF was found, suggesting that their use may be beneficial for most individuals with HF

Efficacy of apatinib 250 mg combined with chemotherapy in patients with pretreated advanced breast cancer in a real-world setting

ObjectivesThis study evaluated the efficacy and safety of apatinib (an oral small-molecule tyrosine kinase inhibitor targeting VEGFR-2) 250 mg combined with chemotherapy in patients with pretreated metastatic breast cancer in a real-world setting.Patients and methodsA database of patients with advanced breast cancer who received apatinib between December 2016 and December 2019 in our institution was reviewed, and patients who received apatinib combined with chemotherapy were included. Progression-free survival (PFS), overall survival (OS), the objective response rate (ORR), the disease control rate (DCR), and treatment-related toxicity were analyzed.ResultsIn total, 52 evaluated patients with metastatic breast cancer previously exposed to anthracyclines or taxanes who received apatinib 250 mg combined with chemotherapy were enrolled in this study. Median PFS and OS were 4.8 (95% confidence interval [CI] = 3.2–6.4) and 15.4 months (95% CI = 9.2–21.6), respectively. The ORR and DCR were 25% and 86.5%, respectively. Median PFS for the previous line of treatment was 2.1 months (95% CI = 0.65–3.6), which was significantly shorter than that for the apatinib–chemotherapy combination (p &lt; 0.001). No significant difference was identified in the ORR and PFS among the subgroups(subtypes, target lesion, combined regimens and treatment lines). The common toxicities related to apatinib were hypertension, hand-foot syndrome, proteinuria, and fatigue events.ConclusionApatinib 250 mg combined with chemotherapy provided favorable efficacy in patients with pretreated metastatic breast cancer regardless of molecular types and treatment lines. The toxicities of the regimen were well tolerated and manageable. This regimen could be a potential treatment option in patients with refractory pretreated metastatic breast cancers

Performance Investigation of Linear Compressor With One Side Springs

In this paper a linear compressor prototype with a set of cylindrical coil springs connected to one side of the trestle is developed. The initial position of piston head is near to the top dead center and coil springs are on free status. The experiments on the prototype are carried out by compressing air on different working conditions. The experimental results show that the linear compressor with one side springs can take good advantage of the gas springcharacteristics of the compressed work fluid to reduce the stiffness of mechanical spring and the weight of compressor. However the mechanical springs cannot help to constrain the piston bumping the cylinder head. The performance of the linear compressor prototype with one side springs changes with the discharge pressuresensitively. The discharge volume of the prototype on 0.2MPa is only 24.7% of that on 0.6MPa. The highest efficiency of the prototype is about 82.5% on discharge pressure of 0.5MPa and it drops with the decreasing of discharge pressure or discharge volume. On each condition with different discharge pressure or discharge volume, there exists the highest efficiency by changing the frequency. Therefore the linear compressor with one side springs is more suitable for the application that the cooling capacity need to be reduced with the decreasing of condensing temperature

Towards Statistically Strong Source Anonymity for Sensor Networks

Abstract—For sensor networks deployed to monitor and report real events, event source anonymity is an attractive and critical security property, which unfortunately is also very difficult and expensive to achieve. This is not only because adversaries may attack against sensor source privacy through traffic analysis, but also because sensor networks are very limited in resources. As such, a practical tradeoff between security and performance is desirable. In this paper, for the first time we propose the notion of statistically strong source anonymity, under a challenging attack model where a global attacker is able to monitor the traffic in the entire network. We propose a scheme called FitProbRate, which realizes statistically strong source anonymity for sensor networks. We also demonstrate the robustness of our scheme under various statistical tests that might be employed by the attacker to detect real events. Our analysis and simulation results show that our scheme, besides providing source anonymity, can significantly reduce real event reporting latency compared to two baseline schemes. Index Terms—security and privacy, source anonymity, statistical test, SPRT, sensor networks I